Thursday, 14 February 2013

First patients

This time exactly a year ago I'd just come out of my first medical school interview, not feeling particularly happy with what I felt had been a rather intense grilling. Happily, the next day I had another interview which went much better, and which was followed by an unconditional offer three weeks later. Six months after that I started medical school, and here I am, five and a half months later and having seen my first patients during the past week. Things have certainly changed in the last 12 months, that's for sure.

If I'm perfectly honest with you, pre-clinical medicine hasn't felt totally unlike my previous degrees in the medical sciences. What I mean by this is that so far our the way we learn and are taught hasn't been all that different to any other undergraduate's (except in terms of the volume, which is a lot more now) but generally we still work out of textbooks, fall asleep in lectures, do exercises to consolidate our knowledge, that kinda thing. In short, it doesn't feel radically different to a normal science degree.

Of course, there are differences, for example, this is the first year since primary school where I haven't set foot in a lab, even once. That's something which I'm very thankful for. And also, whilst pre-clinical medicine may be theoretical and sometimes rather dry, it's still a lot more relevant and applicable than the stuff we were taught in biomed. Learning about the individual muscles of the upper limb isn't particularly fun (I'm a physiology/pathology kinda guy, anatomy is definitely not my scene) but at least you can see why it's relevant, even if it also feels so overwhelmingly detailed that it makes you want to run screaming from the lecture theatre. But at any rate it feels a lot more personally relevant than learning how to manipulate a fruitfly's genome. There are also lectures on the social and psychological aspects of medicine, rather than a heavy emphasis just on scientific theories. So there are definite differences even if, on the whole, pre-clinical medicine is still very theoretical.

However, as medical education has become more integrated over the past few years, even during pre-clinical medicine some basic clinical skills are taught and patient contact is gradually introduced. So last term we learnt how to take a history, different systems examinations, etc so that this term we can actually put them in practice when meeting patients, which is what happened this week.

First patient

The first patient was recovering on a surgical ward after an operation to fix a hernia. The task for this week was to practice history taking and any relevant systems examinations. A quick briefing at first in the hospital lecture theatre to remind us of what we should be saying and asking, and then we split up into smaller groups to shadow the doctors who would be observing us as we took our histories. Interestingly enough, though this was a real patient, I felt I actually managed to take a better history than during my OSCE with a simulated patient. Maybe it was because it was in a ward setting, maybe because there wasn't an examiner scribbling away furiously whilst I was at it, but at any rate I took the history and performed an abdominal examination (though carefully avoiding the site of the operation). The patient was very nice and happy to help out, which was very kind of them and definitely put me at ease too! The junior doctor who was observing me said that I'd done well with both the history and the examination, so I left feeling pretty happy about it all. Learning about hernias in the lecture theatre is interesting enough, but it feels a lot more real when you actually hear about it in the context of someone's personal experiences: both when they describe the initial pain it caused them and then their feelings of relief after it had been fixed.

I'm glad that of all the patients I'll see throughout my professional career, this first one left such a positive and good impression on me. It could have been very different I guess: patients are often tired, stressed out or simply not in the mood to be quizzed by med students. The fact that this patient put me at ease is something I'm very grateful for.

Second and third patients

The second and third patients I saw were seen a few days later in an outpatient clinic and again I was here to practice history taking, this time for a case report. Both patients were HIV positive, and this was my first encounter with an HIV positive patient. The thing I like most about clinical medicine with real patients is that it makes you learn from the moment you enter the room. My first recollections relating to HIV/AIDS are of seeing Princess Diana on the news visiting AIDS patients in a hospital in England in the 1990s, and those patients definitely didn't look well at all. So, in my mind I imagined that the patients I would be seeing today would probably be very poorly too.

Things couldn't have been more different actually. The first patient was in his third decade of living with HIV/AIDS, was in his 80s, and was (according to the notes and history) perfectly healthy otherwise. I quickly realised that what I had read about anti-retroviral drugs being able to effectively control HIV wasn't only true for the young or for the recently diagnosed, but that HIV patients who have access to the appropriate medications can have a near-normal life expectancy (or in some cases, wholly normal), something which the consultant reiterated to me after I took the history. You can read about this stuff in a book, or you can actually see it up close and personal, and I definitely know which has made a bigger impression on me!

The second patient was a few years younger than the first and again, otherwise healthy and very proud of it. I had a bit more time with this patient and we managed to talk about things other than the medicine whilst waiting for the consultant to return. During this time the patient informed me that the number of countries they had visited over the years was nearly in triple figures, and due to carry on rising over the coming months - something I found very impressive, considering mine is still in single figures. I suppose, deep down, I'm a bit nosy. Actually nosy is the wrong word; more like perennially curious. I'm curious to hear about what other people do with their lives, where they live, where they grew up, where they went to school, where they go on holiday etc. Maybe this stems from the fact that I feel my own life is pretty standard, so I like hearing about how different life is for other people. It's definitely one of the most interesting aspects of medicine for me.

Anyway, I probably won't be updating this thing every time I see a new patient, but since these were my first three and since they each made an impression on me for different reasons, I felt the need to reflect a bit. I'm glad that medical schools now include patient contact before the clinical years, as it can be educational, motivational and pretty fun too. Next time I'm grappling with how best to commit a list of muscles to memory, I'll definitely feel a lot more motivated knowing that if I can get through pre-clinical medicine, there will be many more interesting patients to see in the clinical years and beyond!

Also, I know it's been a while since I updated - there's been a slight administrative hold-up with my Semester 1 exam results, hence why I haven't posted on here to gloat/moan as per usual. As soon as I hear back I'll update. Hope you're all doing well and enjoying the new term!